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Med/Surg
Test 1 - Cardiac
| Question | Answer |
|---|---|
| Where is the SA node located and what is its normal rate? | junction of the superior vena cava and the right atrium - 60 to 100 |
| Where is the AV node located and what is its firing rate | right atrial wall near the tricuspid valve - 40 to 60 |
| What is the Cardiac Electrophysiology of the heart (the order) | SA node --- AV node ---- Bundle of Hiss --- Right and Left Branches ----Purkinje fibers |
| What is the largest chamber of the heart? | Left ventricle |
| A patient may undergo an ___________________ study in which electrodes are placed inside the heart in order to obtain an intracardiac ECG. | electrophysiology (EP) |
| This is used to diagnose the dysrhythmia and to determine determine the most effective treatment plan. | electrophysiology (EP) study |
| standard 12-lead ECG reflects the electrical activity primarily in the ___________ | left ventricle - Note in patients with suspected right-sided heart damage, right-sided precordial leads are required to evaluate the right ventricle. |
| How is an EPS study done? | temp pacemaker wires may be lightly sutured to the epicardium & brought through the chest wall. Wires may be used for temporary pacing & obtaining an atrial ECG - helpful in the differential diagnosis of tachydysrhythmias. |
| During diastole the mitral and tricuspid valves are ____. | open |
| Where is the apical impulse or PMI (point of maximal impulse) located? | 5th intercostal space |
| What is the relaxation phase of the heart refereed to as? | Diastole |
| What is the contraction phase of the heart refereed to as? | Systole |
| T or F - The right ventricle is two to three times more muscular than the left ventricle. | the left ventricle. F - left is thicker because it must overcome high aortic and arterial pressures. |
| The ___________- valves are closed during diastole. | semilunar |
| The coronary arteries are perfused during what? How would a faster heart rate effect perfusion? | diastole - with a normal heart rate of 60 to 80 bpm there is a lot of time during diastole for perfusion. Increased heart rate shortens diastole and may lead decrease myocardial perfusion. This puts the patient at risk for myocardial ischemia. |
| _________ is the total amount of blood ejected by one of the ventricles in liters per minute. __________ is the amount of blood ejected from one of the ventricles per heart beat. | Cardiac output, stroke volume |
| What are the three factors that determine stroke volume? | preload, afterload, contractility |
| How do the hearts of men and women differ. | Men generally have bigger hearts and women tend to have more narrow coronary arteries. |
| The three major effecs of estrogen are? | 1) an increase in high-density lipoprotein (HDL) that transports cholesterol out of arteries (2) a reduction in low-density lipoprotein (LDL) that deposits cholesterol in the artery 3) dilatation of the blood vessels- enhance blood ow to the heart. |
| What are two major negative change of the heart that occur with aging? What are the effects? | 1. loss of function of the cells throughout the conduction system leads to a slower heart rate. 2. Increase heart size -hypertrophy (thickening of the heart walls), which reduces the volume of blood that the chambers can hold. |
| What are four major barriers related to cardiac symptoms that lead to people not seeking prompt medical service. | 1.lack of knowledge about the symptoms of heart disease 2. attributing symptoms to a benign source 3. denying symptom significance 4. feeling embarrassed about having symptoms |
| What are the most common S/S of CVD | - Chest pain or discomfort - Shortness of breath or dyspnea - Peripheral edema, weight gain, abdominal distention due to enlarged spleen and liver or ascites (HF) - Palpitations - Unusual fatigue - Dizziness, syncope, or changes in LOC |
| _______________________________is an emergent situation characterized by an acute onset of myocardial ischemia that results in myocardial death (i.e., MI) if denitive interventions do not occur promptly. | Acute coronary syndrome (ACS) aka unstable angina |
| To differentiate among the causes of chest pain, the nurse asks the patient what three things? | 1.to identify the quantity (0 = no pain to 10 = worst pain) 2. location 3. quality of pain. |
| During an ______, patients may report chest pain from myocardial ischemia, shortness of breath from Heart Failure, and palpitations from dysrhythmias. Both HF and dysrhythmias can be complications of an acute MI. | MI |
| What are some important points to keep in mind when assessing patents reporting chest pain? | - The location of chest symptoms is not well correlated with the cause of the pain. - The severity or duration of chest pain or discomfort does not predict the seriousness of its cause. -More than 1 clinical cardiac condition may occur simultaneously |
| Some non modifiable risk factors related to cardiac issues include age. male sex and race. List 6 modifiable risk factors. | 1. smoking 2. Hypertention (drugs can be taken to lower this) 3. High cholesterol 4. Diabetes 5. Obesity 6. Physical inactivity These can all be modified by lifestyle changes or medications. |
| Characteristics of what? Uncomfortable pressure, squeezing or fullness in substernal chest. Can radiate across chest to the medial aspect of 1 or both arms, jaw, shoulders, upper back, or epigastrium. Radiation to arms & hands - (numbness or aching.) | Angina |
| What is the duration of Angina? What are the precipitating events and aggravating factors? | 5 to 15 minutes - physical exertion, emotional upset, eating large meals or expose to extremes in temperature |
| Characteristics of what? Same S/S of Angina Pectoris. Pain or Discomfort ranges from mild to sever. Associated with shortness of breath, diaphoresis, palpitations, unusual fatigue, and N/V | ACS aka Unstable angina |
| Alleviating factors for Angina (list 4) | Rest, nitroglycerin, oxygen and pain management |
| Alleviating factors for ACS aka unstable angina (list 2) | 1. morphine 2. reperfusion of coronary artery with thrombolytic (fibrinolytic) agents or percutaneous coronary intervention |
| What is the term for Suddenly awakening with shortness of breath ? What is this a symptom of? | Paroxysmal Nocturnal dyspnea - This is a symptom of worsening heart failure. |
| What causes Paroxymal nocturnal dyspnea? | Reabsorption of fluid from dependent areas of the body (arms & legs) back into the circulatory system within hours of lying in bed. Shift increases preload & places increased demand on the heart of patients with HF, causing sudden pulmonary congestion. |
| Patients with worsening HF often experience________, a term used to indicate the need to sit upright or stand to avoid feeling short of breath. What will patients experiencing report? | breath. What will patients experiencing report? orthopnea - Patients experiencing orthopnea will report that they need to sleep upright in a chair or add extra pillows to their bed. |
Created by:
sbertelsen
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